[Epidemio-clinical and seminal profile of the man consulting for the desire to procreate: current situation in Lubumbashi, in the Democratic Republic of Congo]. / Profil épidémio-clinique et séminal de l'homme consultant pour désir de procréation: état des lieux à Lubumbashi, en République Démocratique du Congo.

Introduction: in Lubumbashi, as in upscale areas where explorations of fertility are very clever, the spermogram remains the essential analysis in the diagnosis of male infertility. This is the cause of 40% of couple infertility. The spermogram is the first step in identifying seminal abnormalities. The objective of this study was to determine the epidemiological-clinical and seminal profile of the man consulting for the desire to procreate in Lubumbashi. Methods: this was a cross-sectional study. We received 202 subjects in Lubumbashi, whose spermogram was performed from August 1st, 2020 to July 31st, 2021. The semen parameters were studied and interpreted according to WHO standards (2010) with studies of factors associated with their disturbance. Bivariate and multivariate analyzes had been carried out. The statistical significance threshold was set at p < 0.05. Results: the epidemiological-clinical profile of the respondents was as follows: the most represented age group was 30 to 39 years; infertility was primary in 80.69% of cases; the duration of the desire for paternity was 2 years at most in 44.55% of cases. The sperm abnormalities found were: oligozoospermia (40.09%), azoospermia (11.38%), asthenozoospermia (18.31%) and teratozoospermia (10.39%). Oligozoospermia was significantly associated with varicocele (ORa = 10.9 [3.0-39.5]; p < 0.0001), genital infection (ORa =2.7 [1.0-7, 2]; p = 0.041) and obesity (ORa = 2.6 [1.0-7.9]; p = 0.020) while azoospermia was the cure for inguinal hernia (ORa = 4.2 [1.0-17.2]; p = 0.049) and malnutrition (ORa =6.0 [1.2-29.7]; p = 0.027). Asthenozoospermia was significantly associated with the age group of 40 to 49 years (ORa = 6.6 [1.2-37.4]; p = 0.034), tobacco (ORa =7.5 [2.7 -21.0]; p = 0.000), undernutrition (ORa = 7.7 [1.0-61.9]; p = 0.045) and overweight (ORa =3.8 [1.3-11, 5]; p=0.019). Teratozoospermia was significantly associated with smoking (ORa = 5.6 [1.8-17.7]; p = 0.003) and overweight (ORa =5.3 [1.2-23.3]; p = 0.027). Conclusion: more than half of the respondents had, of the three main fertility parameters, at least one that was disturbed. Sperm count was the most affected parameter. Alcohol, tobacco, genital infection and malnutrition were the most common risk factors for the abnormalities observed.

[Maternal and fetal outcomes of unattended pregnancies in Lubumbashi, Democratic Republic of Congo]. / Issues materno-fœtales des grossesses non suivies à Lubumbashi, République Démocratique du Congo.

INTRODUCTION: Unattended pregnancies are characterized by significant morbidity maternal and morbidity and mortality fetal. This study aims to determine the frequency of unattended pregnancies, to describe the socio-demographic profile and to assess the maternal and fetal outcomes during childbirth among women who did not attend antenatal care (ANC) in the city of Lubumbashi. METHODS: It was an analytical cross-sectional study of maternal pregnancy from December 2013 to May 2014 in 10 maternity hospitals in Lubumbashi. Women who did not receive ANC were compared to women who had followed them (ANC≥4). Maternal socio-demographic parameters, maternal and perinatal morbidity and mortality were analyzed. RESULTS: We found that the frequency of no pregnancy monitoring was 21.23% and the mean number of antenatal visits was 2.6 ± 1.9. An analysis of the relationship between ANC and socio-demographic characteristics of women who were delivered shows that the lack of follow-up was 2.29 times higher for adolescent girls than for adult women (OR=2.29 [1.54-3.41]), 4 times higher for women living alone than for women living in unions (OR=4.00 [2.05-7.79]) and 4.08 times higher for women with low levels of education (illiterate or primary) than among those with a high level of education (OR=4.08 [3.08-5.40]). Compared to those who followed them well, we did not find that women who did not attend ANC had a high risk of obstetric emergency (OR = 1.90 [1.26-2.95]), rupture of membranes fetal admission (OR=1.31 [1.02-1.68]), fetal mal presentation (OR=1.89 [1.03-3.44]), caesarean delivery (OR=1.78 [1.21-2.63]), eclampsia (OR=3.00 [1.09-8.70]), uterine rupture (OR=4.76 [1.00-47.19]) and anemia (OR=2.33 [1.06-5.13]). Rates of preterm birth (OR = 1.93 [1.33-2.80]), post-maturity (OR=1.47 [1.00-2.30]), low birth weight (OR=2.33 [1.56-3.46]), neonatal depression (OR=3.89 [2.52-6.02]), neonatal transfer (OR=1.60 [1.11-2.32]) and perinatal mortality (OR=2.70 [1.59-4.57]) were significantly higher in neonates from women with prenatal consultations than in those with well followed. CONCLUSION: Our study shows that the lack of follow-up of ANC is associated with high maternal morbidity and high perinatal morbidity and mortality in our environment.

[Model predicting failure in surgical repair of obstetric vesicovaginal fistula]. / Modèle prédictif de l'échec de la réparation chirurgicale de la fistule obstétricale vésico-vaginale.

INTRODUCTION: There are more than 2 million cases of genital fistula in sub-Saharan Africa and in Asia. They occur in people living in areas where the access to medical care during pregnancy and childbirth are limited or of poor quality and where few hospitals can provide adequate surgical repair. The purpose of this study was to develop a score to predict the factors influencing failure in surgical repair of obstetric vesicovaginal fistula (VVF) in the southeastern part of the province of the Upper Katanga. METHODS: We conducted a cross-sectional analytical study of 384 women with vesicovaginal fistula who had undergone surgery. We performed a multivariate and then a univariate analysis. The discrimination of the score was assessed using the ROC curve and the C-index while the calibration of the score using Hosmer-Lemeshow's test. RESULTS: Surgical repair of obstetric vesicovaginal fistula failed in 17.19% of cases (66/384). After logistic modelling, four criteria emerged as predictors of failure in surgical repair of vesicovaginal fistula: the presence of a fibrotic scar (OR=15.22; CI 95%: 7.34-31.58), the presence of 2 fistulas or more (OR=7.41; CI 95%: 3.05-17.97), transvescical approach (OR=4.26; CI 95%: 1.92-9.44) and urethral involvement (OR=3.93; CI 95%: 1.99-7.77). The area under the ROC curve for the score was 0.8759, with a sensitivity of 57.58%, a specificity of 91.82% and a positive predictive value of 91.25%. CONCLUSION: This study demonstrated that the number of fistulas, the presence of fibrotic scar, urethral involvement and transvescical approach are predictors of failure in surgical repair of vesicovaginal fistula.

[Obstetric fistulas among people living in northern Katanga province, Democratic Republic of the Congo: about 242 cases]. / Fistules obstétricales dans la province du Haut-Katanga, République Démocratique du Congo: à propos de 242 cas.

Obstetric fistulas are a major public health problem in poor countries. This study aimed to describe the epidemiological, clinical and therapeutic features of obstetric fistulas in northern Katanga province, Democratic Republic of the Congo. We conducted a descriptive cross-sectional study of 242 patients with obstetric fistula living in northern Katanga province from September 2009 to December 2013. The parameters studied included maternal sociodemographic data, obstetric and neonatal parameters, specific features of the fistula as well as management approach and outcome. Variables were analyzed using Epi Info 7.1 software. Out of 242 patients with obstetric fistula, 229 (95%) patients delivered vaginally and among them 74.6% delivered at home. In 93,4% of cases the new-born died in the perinatal period. The average age of patients was 27.9 ± 10.3 years. One out of six patients had less than 20 years and in general almost 1 out of 2 patients had less than 25 years. Seven out of ten patients had a parity of less than 3 and the average parity was 2.5±2.0. Ninety percent of patients had a low educational level and 95% lived alone. The patients had, on average, a history of fistula of more than 4.7±4.4 years, it was a vesico-vaginal fistula (96%) type 2-3 (37%) and it was repaired using a transvaginal approach (67%). The average failure rate was 14%. Obstetric fistula is a real public health problem in our environment and it deserves further consideration to be eradicated.

[Childbirth among primiparous women in Lubumbashi: maternal and perinatal prognosis]. / Accouchement chez la primipare à Lubumbashi: pronostic maternel et périnatal.

INTRODUCTION: Childbirth in primiparous women is associated with many complications and, therefore, primiparous women are considered high risk due to maternal and fetal concerns. This study aims to determine birth rate in primiparous women in our environment, to identify factors associated with delivery by cesarean section and to assess maternal and perinatal morbi-mortality from childbirth in primiparous women living in Lubumbashi. METHODS: We conducted a cross-sectional, analytical study of singleton births in 10 referral maternity hospitals in Lubumbashi over the period December 2013-May 2014. Primiparous births were compared to multiparous births. Maternal sociodemographic parameters as well as maternal and perinatal morbi-mortality were analyzed. The odds ratio and its confidence interval were calculated. Threshold significance level was set at p < 0.05. RESULTS: Primiparity rate was 19.9%. Compared to multiparous births, primiparous births were mainly observed in adolescents (OR=11. 27, (7.98-15.91)), in students (OR = 5.61 (3.33-9.45)) and in women living alone (OR=7.62 (4.36-13.30)). Risk factors associated with delivery by cesarean section in primiparous women included obstetric evacuation (OR = 9.69 (4.75-19.74)), the lack of prenatal monitoring (OR=2.57, (1.32-5.01)), size ≤ 150 cm (OR = 2.42 (1.04-5.65)), uterine height > 34 cm (OR = 2.33 (1.32-4.10)) and malpresentation (OR = 6.37 (2.92-13.87)). With regard to maternal prognosis, we observed that high blood pressure (OR = 1.91 (1.32-2.74)), malpresentation (OR = 1.95 (1.16-3.17)), oxytocin use (OR = 2.03 (1.64-2.52)), cesarean section (OR = 2.04 (1.47-2.83)), episiotomy (OR=11.89 (8.61-16.43)) and eclampsia (OR = 4.21 (1.55-11.44)) were significantly associated with primiparity. The rates of low 5th minute Apgar score (OR = 1.55 (1.03-2.32)) and of deaths occurred during early neonatal period (OR=1.80 (1.08-2.98)) were significantly higher in primiparous women than in multiparous women. CONCLUSION: This study shows that primiparous birth is a problem in Lubumbashi. Hence improvement in mother-child care during primiparous childbirth includes the development of protocols for adequate management of childbirths.

Profile of delivering mothers in Lubumbashi, Democratic Republic of the Congo

The aim of our study was to establish an inventory of deliveries in Lubumbashi, Democratic Republic of Congo. We carried out a descriptive study in 10 General Reference Hospitals in the city from 1 December 2013 to 31 May 2014. The study reports that pregnant mothers in Lubumbashi deliver at a mean age of 28.2 years. The women have a mean parity of 3.8, they are married (97.7%), overweight (mean BMI 25.68 kg/m2) and had 2.6 antenatal care on mean. The primary mode of delivery was spontaneous vaginal delivery (91.7%). About 10% of mothers had a complication dominated by perineal or vaginal tears and haemorrhagic complications. Newborns weighed on average 3121.2 grams and 0.56% had a congenital malformation dominated by polydactyly and cleft-palate. Maternal and perinatal mortality rates were 310 per 100,000 live births and 42.4 per 1,000 live births, respectively

Gestational Trophoblastic diseases: alternatives to biological monitoring in under-resourced settings (Two clinical observations)

Gestational trophoblastic disease (GTD) is a condition requiring regular monitoring of hormone human chorionic gonadotropin (HCG). The semi-quantitative method presented here is an alternative for monitoring in under-equipped environments. The illustration made from two clinical cases of GTD that we have followed shows that this method can be used in under-equipped settings and where the quantitative dosage is unavailable